Epidemiology of perinatal OCD
(Dennis, Falah-Hassani, & Shiri, 2017) : Systematic review of all studies of the prevalence of anxiety symptoms and anxiety disorders in pregnancy and postnatally. 15.2% of women have an anxiety disorder in pregnancy and 9.9% postnatally.
(Fairbrother, Janssen, Antony, Tucker, & Young, 2016) : This study highlighted a prevalence of 1% in pregnancy and 2.9% postnatally. In this study anxiety disorders were more common than depression and there was not much overlap.
(Russell, Fawcett, & Mazmanian, 2013). Meta-analysis of prevalence studies indicates raised risk of OCD in pregnancy and postnatal period. However, many studies in the analysis are not particularly robust.
(McGuinness, Blissett, & Jones, 2011). Good analysis and critique of whether perinatal OCD is distinctive. Concludes that there is mixed evidence for raised prevalence but that the focus of the disorder in terms of symptoms and perinatal context is very important.
Normal intrusive thoughts in the perinatal period
(Fairbrother & Woody, 2008). This study demonstrated that intrusive thoughts of all types including deliberate and accidental harm are experienced by mothers who do not have OCD.
(Jonathan S. Abramowitz, Schwartz, & Moore, 2003). This study demonstrated that intrusive thoughts about the infant are common in mothers and fathers.
Risk Factors related to the development of perinatal OCD
(Timpano, Abramowitz, Mahaffey, Mitchell, & Schmidt, 2011) : A randomised trial in which an intervention was given targeting beliefs about thoughts. Reduced obsessive-compulsive symptoms were seen in the intervention group, supporting the concept of prevention.
(Forray, Focseneanu, Pittman, McDougle, & Epperson, 2010). Suggests that for a subgroup of women reproductive hormones may have an effect on OCD symptoms.
(Fairbrother & Abramowitz, 2007); Discussed new parenthood as a risk factor for OCD due to the increase in responsibility experienced by all parents, the increase in thoughts of harm at this time.
(J. S. Abramowitz, Khandker, Nelson, Deacon, & Rygwall, 2006). Elegant study showing that beliefs about thoughts predicted distress caused by postnatal intrusive thoughts in mothers and fathers.
(Maina, Albert, Bogetto, Vaschetto, & Ravizza, 1999). Important early study identifying the link between pregnancy and birth and the exacerbation or onset of OCD.
Identification of perinatal OCD
(Ford, Shakespeare, Elias, & Ayers, 2017) : This review highlighted that GPs need more training to recognise depression and anxiety disorders.
(Fiona L. Challacombe & Wroe, 2013). This paper presents two case studies in which OCD was misdiagnosed and outlines the implications for the mothers and their babies from the incorrect risk assessment and lack of effective treatment.
(Matthey, Barnett, Howie, & Kavanagh, 2003) : Study highlighting that due to the focus on depression in assessment, anxiety is often missed.
Impact of perinatal OCD
(Fiona L. Challacombe et al., 2016). This study showed that women with OCD feel a high level of impact on quality of life and parenting tasks. Partner relationships and perceived social support are also impacted by OCD.
(Gezginc et al., 2008). Highlights the impact on quality of life of OCD in pregnancy.
Treatment of perinatal OCD
(F. L. Challacombe et al., 2017): A randomised controlled trial of intensive CBT for postnatal OCD, compared with treatment as usual. Found that mothers improved with the two-week treatment which was superior to treatment as usual. Treatment as usual varied widely.
(Marchesi et al., 2016): A review of current evidence for the treatment of anxiety disorders in pregnancy and postnatally. There is still little specific evidence beyond case series.
(Jonathan S. Abramowitz et al., 2013). Evidence for a couples based approach to treatment where one partner has OCD. Has not been specifically tested in the perinatal population.
(Hudak & Wisner, 2012). Describes approaches to the treatment of intrusive thoughts of harm that can occur in OCD and depression.
(Fiona L. Challacombe & Salkovskis, 2011) : A case series of six women treated with intensive CBT who improved on symptoms and reported a positive impact on parenting.
NICE GUIDELINE CG92. Outlines that women with anxiety disorders should be seen for treatment within a month of assessment
Fathers with OCD
(J. S. Abramowitz et al., 2006). Showed that both mothers and fathers without ocd experience intrusive thoughts and also respond to those thoughts.
(J. Abramowitz, Moore, Carmin, Wiegartz, & Purdon, 2001) : a case series of four fathers who experienced postnatal OCD after the birth of their child.
We would like to thank Dr Fiona Challacombe for her support in sourcing and writing this part of the site.
Abramowitz, J., Moore, K., Carmin, C., Wiegartz, P., & Purdon, C. (2001). Acute onset of obsessive-compulsive disorder in males following childbirth. Psychosomatics: Journal of Consultation Liaison Psychiatry, 42(5), 429-431.
Abramowitz, J. S., Baucom, D. H., Boeding, S., Wheaton, M. G., Pukay-Martin, N. D., Fabricant, L. E., . . . Fischer, M. S. (2013). Treating obsessive-compulsive disorder in intimate relationships: A pilot study of couple-based cognitive-behavior therapy. Behavior Therapy, 44(3), 395-407. doi: http://dx.doi.org/10.1016/j.beth.2013.02.005
Abramowitz, J. S., Khandker, M., Nelson, C. A., Deacon, B. J., & Rygwall, R. (2006). The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study. Behav Res Ther, 44(9), 1361-1374. doi:10.1016/j.brat.2005.09.011
Abramowitz, J. S., Schwartz, S. A., & Moore, K. M. (2003). Obsessional thoughts in postpartum females and their partners: Content, severity, and relationship with depression. Journal of Clinical Psychology in Medical Settings, 10(3), 157-164. doi:http://dx.doi.org/10.1023/A:1025454627242
Challacombe, F. L., & Salkovskis, P. M. (2011). Intensive cognitive-behavioural treatment for women with postnatal obsessive-compulsive disorder: A consecutive case series. Behaviour Research and Therapy, 49(6-7), 422-426. doi:http://dx.doi.org/10.1016/j.brat.2011.03.006
Challacombe, F. L., Salkovskis, P. M., Woolgar, M., Wilkinson, E. L., Read, J., & Acheson, R. (2016). Parenting and mother-infant interactions in the context of maternal postpartum obsessive-compulsive disorder: Effects of obsessional symptoms and mood. Infant Behavior and Development, 44, 11-20. doi:http://dx.doi.org/10.1016/j.infbeh.2016.04.003
Challacombe, F. L., Salkovskis, P. M., Woolgar, M., Wilkinson, E. L., Read, J., & Acheson, R. (2017). A pilot randomized controlled trial of time-intensive cognitive-behaviour therapy for postpartum obsessive-compulsive disorder: effects on maternal symptoms, mother-infant interactions and attachment. Psychological Medicine, 47(8), 1478-1488. doi:10.1017/s0033291716003573
Challacombe, F. L., & Wroe, A. L. (2013). A hidden problem: consequences of the misdiagnosis of perinatal obsessive-compulsive disorder. British Journal of General Practice, 63(610), 275-276. doi:http://dx.doi.org/10.3399/bjgp13X667376
Dennis, C.-L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. The British Journal of Psychiatry. doi:10.1192/bjp.bp.116.187179
Fairbrother, N., & Abramowitz, J. S. (2007). New parenthood as a risk factor for the development of obsessional problems. Behaviour Research and Therapy, 45(9), 2155-2163. doi:http://dx.doi.org/10.1016/j.brat.2006.09.019
Fairbrother, N., Janssen, P., Antony, M. M., Tucker, E., & Young, A. H. (2016). Perinatal anxiety disorder prevalence and incidence. Journal of Affective Disorders, 200, 148-155. doi:http://dx.doi.org/10.1016/j.jad.2015.12.082
Fairbrother, N., & Woody, S. R. (2008). New mothers’ thoughts of harm related to the newborn. Archives of Women’s Mental Health, 11(3), 221-229. doi:http://dx.doi.org/10.1007/s00737-008-0016-7
Ford, E., Shakespeare, J., Elias, F., & Ayers, S. (2017). Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review. Fam Pract, 34(1), 11-19. doi:10.1093/fampra/cmw101
Forray, A., Focseneanu, M., Pittman, B., McDougle, C. J., & Epperson, C. (2010). Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. Journal of Clinical Psychiatry, 71(8), 1061-1068. doi:http://dx.doi.org/10.4088/JCP.09m05381blu
Gezginc, K., Uguz, F., Karatayli, S., Zeytinci, E., Askin, R., Guler, O., . . . Gecici, O. (2008). The impact of obsessive-compulsive disorder in pregnancy on quality of life. International Journal of Psychiatry in Clinical Practice, 12(2), 134-137. doi:http://dx.doi.org/10.1080/13651500701777363
Hudak, R., & Wisner, K. L. (2012). Diagnosis and treatment of postpartum obsessions and compulsions that involve infant harm. The American Journal of Psychiatry, 169(4), 360-363. doi:http://dx.doi.org/10.1176/appi.ajp.2011.11050667
Maina, G., Albert, U., Bogetto, F., Vaschetto, P., & Ravizza, L. (1999). Recent life events and obsessive–compulsive disorder (OCD): the role of pregnancy/delivery. Psychiatry Res, 89(1), 49-58. doi:http://dx.doi.org/10.1016/S0165-1781(99)00090-6
Marchesi, C., Ossola, P., Amerio, A., Daniel, B. D., Tonna, M., & De Panfilis, C. (2016). Clinical management of perinatal anxiety disorders: A systematic review. Journal of Affective Disorders, 190, 543-550. doi:http://dx.doi.org/10.1016/j.jad.2015.11.004
Matthey, S., Barnett, B., Howie, P., & Kavanagh, D. J. (2003). Diagnosing postpartum depression in mothers and fathers: Whatever happened to anxiety? Journal of Affective Disorders, 74(2), 139-147. doi:http://dx.doi.org/10.1016/S0165-0327%2802%2900012-5
McGuinness, M., Blissett, J., & Jones, C. (2011). OCD in the perinatal period: Is postpartum OCD (ppOCD) a distinct subtype? A review of the literature. Behavioural and Cognitive Psychotherapy, 39(3), 285-310. doi:http://dx.doi.org/10.1017/S1352465810000718
Russell, E. J., Fawcett, J. M., & Mazmanian, D. (2013). Risk of obsessive-compulsive disorder in pregnant and postpartum women: A meta-analysis. Journal of Clinical Psychiatry, 74(4), 377-385.
Timpano, K. R., Abramowitz, J. S., Mahaffey, B. L., Mitchell, M. A., & Schmidt, N. B. (2011). Efficacy of a prevention program for postpartum obsessive-compulsive symptoms. Journal of Psychiatric Research, 45(11), 1511-1517. doi:http://dx.doi.org/10.1016/j.jpsychires.2011.06.015